Volume Change of Pedicled Latissimus Dorsi Muscle Flap after Partial Breast Reconstruction

Abstract

Introduction Despite successful breast reconstruction with oversized latissimus dorsi muscle flap after breast-conserving surgery for breast cancer, esthetic problems continue to exist due to flap shrinkage. The purpose of this study was to evaluate the objective volume change of pedicled latissimus dorsi muscle flap when it is used in breast reconstruction.

Methods Patients who were diagnosed with breast cancer and underwent a breast-conserving surgery with immediate breast reconstruction with pedicled latissimus dorsi myocutaneous flap between October 2009 and November 2015 were studied. Eleven patients who were followed up for more than 1 year after operation were included in the study. We evaluated the volume of muscle portion of the latissimus dorsi myocutaneous flap with computed tomography (CT) scan. We analyzed the rate of volume change of the latissimus dorsi muscle every year until 5 years after the operation.

Result The latissimus dorsi muscle flaps of all 11 patients showed a volume decrease over time. The rate of volume change of the latissimus dorsi muscle flaps decreased 8.04% in the first year, 6.36% in the second year, 5.05% in the third year, 2.88% in the fourth year, and 2.56% in the fifth year after operation in average.

Conclusion This research shows the possibility of objectively evaluating the volume change of pedicled latissimus dorsi muscle flaps after breast reconstruction. The findings will be helpful in designing the size of the flaps to use on defects after breast-conserving surgery.

Keywords

volume change - pedicled latissimus dorsi muscle flap - partial breast reconstruction

• References

• 1 Amir A, Silfen R, Hauben DJ. Use of Archimedes' law for measuring the volume of the TRAM flap in immediate breast reconstruction. Plast Reconstr Surg 1999; 103 (04) 1329
• 2 Cho KJ, Joo YH, Sun DI, Kim MS. Perioperative clinical factors affecting volume changes of reconstructed flaps in head and neck cancer patients: free versus regional flaps. Eur Arch Otorhinolaryngol 2011; 268 (07) 1061-1065
• 3 Kääriäinen M, Giordano S, Kauhanen S. , et al. The significance of latissimus dorsi flap innervation in delayed breast reconstruction: a prospective randomized study-magnetic resonance imaging and histologic findings. Plast Reconstr Surg 2011; 128 (06) 637e-645e
• 4 Hiraki A, Yamamoto T, Yoshida R. , et al. Factors affecting volume change of myocutaneous flaps in oral cancer. Int J Oral Maxillofac Surg 2016; 45 (11) 1395-1399
• 5 Fujioka M, Masuda K, Imamura Y. Fatty tissue atrophy of free flap used for head and neck reconstruction. Microsurgery 2011; 31 (01) 32-35
• 6 Sakamoto Y, Takahara T, Ota Y. , et al. MRI analysis of chronological changes in free-flap volume in head and neck reconstruction by volumetry. Tokai J Exp Clin Med 2014; 39 (01) 44-50
• 7 Sakuraba M, Asano T, Miyamoto S. , et al. A new flap design for tongue reconstruction after total or subtotal glossectomy in thin patients. J Plast Reconstr Aesthet Surg 2009; 62 (06) 795-799
• 8 Mücke T, Rau A, Weitz J. , et al. Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions. Oral Oncol 2012; 48 (04) 367-371
• 9 Chatterjee JS, Lee A, Anderson W. , et al. Effect of postoperative radiotherapy on autologous deep inferior epigastric perforator flap volume after immediate breast reconstruction. Br J Surg 2009; 96 (10) 1135-1140
• 10 Shin YS, Koh YW, Kim SH. , et al. Radiotherapy deteriorates postoperative functional outcome after partial glossectomy with free flap reconstruction. J Oral Maxillofac Surg 2012; 70 (01) 216-220
• 11 Yamaguchi K, Kimata Y, Onoda S, Mizukawa N, Onoda T. Quantitative analysis of free flap volume changes in head and neck reconstruction. Head Neck 2012; 34 (10) 1403-1407
• 12 Bittermann G, Thönissen P, Poxleitner P, Zimmerer R, Vach K, Metzger MC. Microvascular transplants in head and neck reconstruction: 3D evaluation of volume loss. J Craniomaxillofac Surg 2015; 43 (08) 1319-1324
• 13 Joo YH, Hwang SH, Sun DI. et al. Assessment of volume changes of radial forearm free flaps in head and neck cancer: Long-term results. Oral Oncology 2011; 47: 72-75
• 14 Williams JK, Carlson GW, Bostwick III J, Bried JT, Mackay G. The effects of radiation treatment after TRAM flap breast reconstruction. Plast Reconstr Surg 1997; 100 (05) 1153-1160
• 15 Zimmerman RP, Mark RJ, Kim AI. , et al. Radiation tolerance of transverse rectus abdominis myocutaneous-free flaps used in immediate breast reconstruction. Am J Clin Oncol 1998; 21 (04) 381-385
• 16 Hanks SH, Lyons JA, Crowe J, Lucas A, Yetman RJ. The acute effects of postoperative radiation therapy on the transverse rectus abdominis myocutaneous flap used in immediate breast reconstruction. Int J Radiat Oncol Biol Phys 2000; 47 (05) 1185-1190
• 17 Chawla AK, Kachnic LA, Taghian AG, Niemierko A, Zapton DT, Powell SN. Radiotherapy and breast reconstruction: complications and cosmesis with TRAM versus tissue expander/implant. Int J Radiat Oncol Biol Phys 2002; 54 (02) 520-526
• 18 Halyard MY, McCombs KE, Wong WW. , et al. Acute and chronic results of adjuvant radiotherapy after mastectomy and Transverse Rectus Abdominis Myocutaneous (TRAM) flap reconstruction for breast cancer. Am J Clin Oncol 2004; 27 (04) 389-394
• 19 Mehta VK, Goffinet D. Postmastectomy radiation therapy after TRAM flap breast reconstruction. Breast J 2004; 10 (02) 118-122
• 20 Huang CJ, Hou MF, Lin SD. , et al. Comparison of local recurrence and distant metastases between breast cancer patients after postmastectomy radiotherapy with and without immediate TRAM flap reconstruction. Plast Reconstr Surg 2006; 118 (05) 1079-1086 , discussion 1087–1088
• 21 Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 2001; 108 (01) 78-82
• 22 Rogers NE, Allen RJ. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap. Plast Reconstr Surg 2002; 109 (06) 1919-1924 , discussion 1925–1926
• 23 Spear SL, Ducic I, Low M, Cuoco F. The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg 2005; 115 (01) 84-95